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August 2, 2011

Study: Unequal access to Canadian trauma centers for women, elderly

By Theresa Boyle
Toronto Star

TORONTO — If you're an older woman seriously injured in an accident, chances are you'll be taken by ambulance to the nearest hospital rather than a trauma centre where survival rates are much higher, says the trauma director at St. Michael's Hospital.

"We know that there are disparities based on age and we know that there are disparities based on gender," says Dr. Avery Nathens. "So if you are an older female, you are not going to have similar access to care as a younger male."

In Ontario, severely injured elderly patients are about 30 per cent less likely to get trauma centre care. Females, in general, are about 10 per cent less likely to receive trauma centre care.

"We don't know why that is but we do know that a trauma centre reduces the risk of death considerably after injury," Nathens says. The trauma surgeon has a big interest in access to care and has created special program at Toronto's St. Mike's to improve trauma care for the elderly.

Of more than 150 hospitals in Ontario, 11 have trauma centres, including St. Mike's and Hamilton General Hospital. The centres operate 24 hours with highly specialized staff and sophisticated diagnostic equipment. Some have helipads.

Previous research by Nathens found that going directly to a trauma centre, even if it means bypassing a closer hospital, results in a nearly 25 per cent lower death rate, as well as savings and improved quality of life for survivors.

When someone is severely injured, in a car accident or shooting for example, paramedics assess a patient and use field triage criteria in deciding whether to transport a patient to the nearest hospital or one with a trauma unit that could be farther away. They look at vital signs, level of consciousness, broken bones, skin penetration and signs of spinal injury.

Age is also among the criteria.

"Age should be a modifying factor, which means that you may have a lesser injury but if you are older you should err on the side of going to a trauma centre," Nathens says. "For some reason, we haven't gotten there yet."

If a trauma centre is too far away, a patient will be taken to a local hospital where an emergency physician can decide to have the patient airlifted to one if the injury is serious enough.

"The biases occur at both the level of the paramedic making decisions and also the doc who decides whether the patient will be transferred to a trauma centre."

Nathens is concerned about inadequate access to trauma centres and has found 62 per cent of seriously injured adults in Ontario are taken to their nearest hospital first and 69 per cent are never transferred to a trauma centre. Those who live farthest away from the centres get short shrift.

He says more than eight in 10 Ontarians would prefer to go to a trauma centre if seriously injured.

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